Basic Information
Provider Information
NPI: 1336467430
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WARD
FirstName: BRYON
MiddleName: SCOTT
NamePrefix: DR.
NameSuffix:  
Credential: DNP, CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 802738
Address2:  
City: KANSAS CITY
State: MO
PostalCode: 641802738
CountryCode: US
TelephoneNumber: 4057425300
FaxNumber:  
Practice Location
Address1: 1900 N 14TH ST
Address2:  
City: PONCA CITY
State: OK
PostalCode: 746012035
CountryCode: US
TelephoneNumber: 5807653321
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/13/2010
LastUpdateDate: 07/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X98852OKY193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000XC02882ARN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
90001705AR MEDICAID


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